Ayurveda Panchakarma: Shat Kriya Kal – Six Stages of Disease Manifestation

Modern medicine recognizes two stages in disease formation. The first is the stage of detection, where clearly distinguishable symptoms have begun to manifest. Complication is the second stage, where disease is so advanced that it effects other areas of the body and is basically irreversible.

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Ayurveda Panchakarma: Shamana and Shodhana Chikitsa – Procedures for Alleviating the Symptoms and Procedures for Eradicating Disease

Ayurveda uses two main modalities in the treatment of disease, each with its own distinct purpose. Shamana therapy is used to palliate or manage the symptoms of disease, whereas shodhana therapy is used to eliminate the cause of disease. Each type of disease management has its own appropriateness depending on the patient, the time and the nature and stage of the illness.

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Ayurveda Panchakarma: Panchakarma – Rejuvenation Therapy

All disease processes point to a crisis of ama toxicity in the body. Panchakarma constitutes the foremost shodhana chikitsa, or purification therapy, because it reverses the disease mechanisms which carry toxic waste products from the digestive tract into the tissues of the body.

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Ayurveda Panchakarma: Dosha Gati in Shodhana Therapy

The doshas provide the vital connection between the gastrointestinal tract and the dhatus, or deep internal structures of the body. It is important to remember that the dhatus comprise the dense, solid structures which do not leave the body, while the malas are the natural waste products of metabolism which are removed from their site of origin and expelled from the body.

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Ayurveda Panchakarma: The Preparatory Procedure of Panchakarma – Snehana, Oleation

Snehana, the first step of Purvakarma, saturates the body with herbal and medicated oils. The saturation takes two forms: bahya snehana or external oleation, where medicated oils are vigorously massaged into the body; and abyantar snehana or internal oleation, where medicated oils are ingested. Snehana uses four types of oleaginous substances: vegetable oils (taila), clarified butter (ghee), animal fats (vasa) and fat from bone marrow (majja). The oils used match the need of the patient.

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Ayurveda Panchakarma: The Preparatory Procedure of Panchakarma – Bahya Snehana, External Oleation

Bahya Snehana: External Oleation

The procedure of bahya snehana or external oleation employs a specific form of massage to apply the herbalized oil to the skin, but it should not be confused with the typical massage techniques used in the West. This process uses a traditional style of Ayurvedic massage whereby two, trained Ayurvedic massage technicians work on both sides of the patient simultaneously, employing a series of perfectly synchronized, directional strokes on both the front and back of the body.

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Ayurveda Panchakarma: Primary Types of Swedana Used in Purvakarma

SWEDANA: THERAPEUTIC HEAT

The second major aspect of the preparatory procedures of Purvakarma is called swedana, the therapeutic application of heat to the body. Though swedana literally means “sweat,” the main purpose of swedana is not to produce sweat, but to dilate the body’s shrotas or channels so that oleation’s objective — removing ama from the dhatus — can be more easily achieved. Sweat results naturally when the channels widen. In addition, the application of heat also counteracts the coldness of both vata and kapha, reduces the body’s stiffness and heaviness, and counters the slow, heavy and sticky attributes of ama.

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Ayurveda Panchakarma: Adjunctive Procedures of Panchakarma

A variety of preparatory procedures can be used not only to enhance elimination and purification during Panchakarma but to replenish and rejuvenate specific zones of the body. They generally employ some form of snehana or swedana, and often address the functions of a particular dosha. These procedures can also be used outside Panchakarma, by themselves, or in conjunction with other treatments, to achieve a specific palliative or nutritive effect either on the whole body or a localized area.

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Ayurveda Panchakarma: Lifestyle Adjustment During Panchakarma

Panchakarma is a powerful therapy that provides a unique opportunity for the system to repair and rejuvenate. Those undergoing this program gain the maximum from it if they focus completely on the healing process taking place. That is why an equally important part of Panchakarma therapy has to do with the patient’s lifestyle during the process. Certain changes in one’s diet and daily routine are necessary to insure the greatest results. These lifestyle adjustments begin with the onset of Purvakarma, the preparatory phase and continue through the end of Paschatkarma, the post-treatment phase.

For Panchakarma to work properly, external demands on the mind and body should be removed. The system can then devote its full resources to eliminating toxins and rejuvenating the dhatus which have been damaged by impurities. Activity or exertion pulls the action of the doshas to the extremities and impairs their ability to transport the impurities from the deep tissues to the G-I tract for elimination.

Ayurveda therefore recommends some lifestyle modifications to maximize the success of treatment, beginning with the onset of the preparatory therapies. Ideally, patients should put aside the usual preoccupation with work and family and devote themselves to rest — mentally and physically. They should have a relaxed schedule and avoid experiences that provoke strong emotions.

It’s important to forego sexual activity during and immediately after treatment to avoid any undue strain on the body’s energy systems. During this time, particularly, patients should not suppress natural urges, such as the need to urinate, defecate or pass gas — the suppression of natural urges always strains the body. Since Panchakarma is contraindicated during menstruation, it is important for women to time their treatment schedule accordingly.

Warm, comfortable and pleasant surroundings, free from drafts, characterize the ideal treatment environment. Baths should always be warm, because the body naturally defends and tightens against cold, whether it’s cold wind, water or drinks. Cold influences also decrease agni’s effectiveness and impair metabolism. In addition, they shrink the shrotas or body channels, which must remain open during Panchakarma to permit the flow of ama out of the dhatus and back to the G-I tract. Through these pathways the healing power of nutrients and medicinal herbs (rasayanas) flow to all parts of the body.

During this time it is important to reduce sensory input and give the senses a much needed rest. Because they are the bridge between our, external and internal worlds, it gives the mind and body rest as well. Patients are advised to avoid television, bright lights and loud music. If reading is necessary, it is best to do it in moderation. It is also recommended that we minimize speech during the time of treatment. We often don’t recognize the effort that goes into producing speech, but it is one of the main ways we expend energy in daily life. Patients should give up strenuous physical exercise during this process. The farther we can pull back into rest, the more dynamic we will be when we spring back into activity once the entire process is complete.

Meditating each day significantly supports successful treatment. Even more benefit comes when meditation is preceded by the gentle stretching and breathing exercises of asanas and pranayama. The benefit of these things has already been discussed.

The diet prescribed during treatment by the Ayurvedic physician constitutes a key element in the therapy. If we tax our digestion with heavy food, it interferes with purification and limits the benefits we might otherwise achieve.

The ideal Panchakarma diet consists of light, nourishing and easily digestible foods, such as steamed vegetables and kichari (yellow mung dal and basmati rice cooked together with very mild spices). The dietary regimen during Panchakarma emphasizes kichari for a number of reasons. It does not tax the digestive agni and when it enters prapaka digestion, it helps to liquefy ama. It is highly nourishing, digests easily and calms the mind. Finally, kichari balances all three doshas. Here is a good recipe for kichari:

Kichari

1 cup split mung dal (yellow)
2 cups white basmati rice 1 inch fresh ginger root
1 small handful of cilantro leaves
2 tsp. ghee (clarified butter)
1/2 tsp. turmeric
1/2 tsp. coriander powder
1/2 tsp. cumin powder
1/2 tsp. whole cumin seeds
1/2 tsp. mustard seeds
1/4 tsp. mineral salts
1 pinch hing (asafoetida)
8 cups water (6 cups when using pressure cooker)

Wash the rice and dal together until the water runs clear. Add the eight cups of water and cook the covered rice and dal until it becomes soft. Saute the mustard seeds, whole cumin seeds, hing, cumin powder, coriander powder and turmeric, together with the ghee, in a separate sauce pan and cook for a few minutes. Stir the sauteed spices into the mostly cooked rice and dal and cook until done. Add the mineral salts and the cilantro leaves before serving.

The daily diet during treatment should avoid heavy foods which are difficult to digest, such as sweets, fried foods, meat and dairy products. Salty foods, pungent foods (chilies, onions and garlic) and sour foods (pickles, vinegar and citrus) should be greatly reduced. Stay away from fermented foods (yogurt, hard cheese, tofu, soy sauce) and foods with yeast (bread). Ayurveda strongly advises abstaining from cold foods and drinks (ice cream, iced teas and sodas), as well as alcohol and stimulants like caffeine. The Panchakarma facility will usually provide the patient with their meals since they know which foods are most conducive to purifying and rejuvenating the body.

If these guidelines are followed from the beginning of the pre-procedures to the end of the post-procedures, Panchakarma therapy will be a great success. The patient will enjoy a strong appetite and digestion and feel light and energetic. The mind will be clear and happy and experience satisfaction and enthusiasm for life.

Now that we have explained the primary and adjunctive therapies which Ayurveda uses to prepare the patient for Panchakarma, as well as the lifestyle adjustments necessary to insure its success, let’s turn our attention to the main eliminative procedures.

Ayurveda Panchakarma: Other Types of Swedana Used as Adjunct Therapies

There are many methods prescribed by the texts to increase heat in the body, though most are seldom used as a part of Panchakarma therapy. Nevertheless, they have a definite benefit and have been employed as effective swedana or heat treatments since ancient times. They all involve applying heat directly to the body, generally or locally, and can use heated substances which are liquid or solid, wet or dry, oily or watery, hard or soft.

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